Mastoid Obliteration with Autologous Bone in Mastoidectomy Canal Wall Down Surgery: a Literature Overview

Abstract

Introduction The objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, the prevention of recurrent disease, and the maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal wall down mastoidectomy has been traditionally used to achieve those goals with greater or lesser degrees of success. However, canal wall down is an aggressive approach, as it involves creating an open cavity and changing the anatomy and physiology of the middle ear and mastoid. A canal wall up technique eliminates the need to destroy the middle ear and mastoid, but is associated with a higher rate of residual cholesteatoma. The obliteration technics arise as an effort to avoid the disadvantages of both techniques. Objectives Evaluate the effectiveness of the mastoid obliteration with autologous bone in mastoidectomy surgery with canal wall down for chronic otitis, with or without cholesteatoma. Data Synthesis We analyzed nine studies of case series comprehending similar surgery techniques on 1017 total cases of operated ears in both adults and children, with at least 12 months follow-up. Conclusion Mastoid Obliteration with autologous bone has been utilized for many years to present date, and it seems to be safe, low-cost, with low recurrence rates - similar to traditional canal wall down procedures and with greater water resistance and quality of life improvements.

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

“…Most studies so far have reported outcomes of CWD surgery with reconstruction of the posterior canal wall and obliteration of the mastoid using varying techniques . Furthermore, although MRI‐DWI has proven to be the most reliable noninvasive technique to detect recurrent or residual cholesteatoma, almost all studies used otoscopy and/or computed tomography (CT) as follow‐up, sometimes combined with a second look at the nonobliterated middle ear only .…”

“…Another argument may be that residual skin is not able to develop into cholesteatoma in a bony obliterated space, which is called the Hinohira effect . Regardless of the causative mechanism, obliteration seems to improve the outcome of cholesteatoma surgery in a variety of studies using different materials for obliteration, ranging from autologous material (e.g., cartilage, bone, musculoperiosteal flaps) to biocompatible alloplastic materials (e.g., hydroxyapatite, bioactive glass) …”

“…15 Regardless of the causative mechanism, obliteration seems to improve the outcome of cholesteatoma surgery in a variety of studies using different materials for obliteration, ranging from autologous material (e.g., cartilage, bone, musculoperiosteal flaps) to biocompatible alloplastic materials (e.g., hydroxyapatite, bioactive glass). 3,5,[7][8][9][10][11][12]16 A huge concern with obliteration has always been the possibility of a silent cholesteatoma within the obliterated cavity. The recent development of MRI-DWI ensures a reliable way to detect such cholesteatoma within the obliterated cavity, mitigating concerns that residual cholesteatoma could be missed.…”

Anatomical, functional and quality‐of‐life results for mastoid and epitympanic obliteration with bioactive glass s53p4: a prospective clinical study

“…Mastoid obliteration is used to reduce the recurrence and the residual rate in primary cholesteatoma surgery using both canal-wall-up 4,5 and canal-wall-down procedures. 14,19,20 Moreover, obliteration of an unstable mastoid cavity leads to significantly better results for discharge, 1,21,22 hearing rehabilitation 23 and imbalance 3 than a revision canal-wall-down procedure. 24 Since 1911, 25 many materials, either autologous or biocompatible, have been used for obliteration.…”

Subtotalis petrosectomia – javallatok, műtéti technika, pécsi tapasztalatok

“…A külső hallójárat porcos és csontos szakaszának határán a bőrt teljesen átvágjuk (anterior irányba is) (2/B ábra). A bőrt gondosan leválasztjuk a tragus porcáról, illetve körkörösen felpreparáljuk, majd a hallójáraton keresztül kifordítjuk [10][11][12]. A kifordított bőrcső anterior és posterior széleit 3.0-ás Vicryl fonallal összevarrjuk (2/C ábra).…”